During the past year we have continued our work applying rapid MRI to guide simple and complex mechanical and biological interventions. We have introduced MRI catheterization into standard clinical practice at the NIH clinical center, based on our earlier careful pilot research comparison of conventional X-ray and wholly MRI guided transfemoral pulmonary artery catheterization in adults. We continue to enhance the capabilities of MRI catheterization to characterize heart function in patients. We continue to test MRI pericardiocentesis procedure in humans. We are developing new approaches to connect different heart chambers without surgery in patients with congenital heart disease. We also continue work towards direct repair of congenital heart defects on small children who otherwise might require open surgical access. We have completed a strategic project to accomplish non-surgical extra-anatomic bypass (a bidirectional Glenn superior cavo-pulmonary shunt) in animals, and expect to be able to translate this into the care of children in upcoming years. We are developing other novel catheterization tools, for example, to access the aorta without surgery in patients with small leg arteries (especially women) and patients with severe peripheral artery disease. This key advance has been translated into over 40 patients in its first year of clinical adoption at multiple sites across the United States, where it has proven lifesaving in many cases. We have now begun to sponsor a multi-center trial of this transcaval approach to transcatheter aortic valve replacement in patients without other good options. Simultaneously we are developing a purpose-built closure device for these caval-aortic access ports. We are helping other US medical centers develop their own interventional MRI programs. Overall we have successfully developed novel applications of real-time MRI for cardiovascular treatments, and we continue to work to clinical applications of these exciting new developments.